Are You Ready to be Audited?

The time to prepare your practice for an audit is now. Failure to prepare could result in large fines and loss of patient trust.

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Failure to plan and prepare for an audit can lead to disastrous results. If you fail to catch mistakes in your billing, you may face hefty fines from the United States Department of Health and Human Services (HHS).

A recent indictment charged a Houston pharmacy owner with $134 Million fraud scheme. He was charged with billing for drugs without a valid prescription, billing for prescriptions after patients’ deaths, and more. In total, he is being charged with eight counts that each carry a possible 10 year prison sentence and $250,000 fine.

While the above example is egregious, billing mistakes do happen and it is essential to prepare your practice for an audit now.

How do you prepare your practice for a potential government audit?

First, start by looking at your last audit results. Did you perform an internal or external audit most recently? Did you correct any areas of concern? If you performed an internal audit or if it’s been awhile, it might be time to hire a healthcare attorney to help with an external, but attorney-client privilege protected audit.

Was your last audit sufficient? Were each of your providers charts audited? When you review your audit, make sure that:

  • There is a sufficient sampling of each practice location (office, clinic, hospital, etc.),
  • Each provider has a sufficient sampling,
  • There is a variety of payors in the sampling, and
  • Any issues were identified, trained on, and fixed.

Also make sure to evaluate your compliance plan. Your compliance plan needs to be more than a binder on a shelf – it should be a comprehensive plan. Your staff need to be aware of the procedures and updates.

If you need help with performing your audit or updating your compliance plan, contact Rickard & Associates today.

In our next blog post, we will keep you informed of related issues.  To get this important information delivered directly to your mail box, 

Do you need help staying current and compliant with the latest laws, rules and regulations?  We can help. To contact us about your new government rules and regulations, your practice’s risk assessment, or about your other legal needs:  CLICK HERE.

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